Premedication with paralysis improves intubation success and decreases adverse events in very low birth weight infants: a prospective cohort study

J Perinatol. 2018 Jun;38(6):681-686. doi: 10.1038/s41372-018-0082-2. Epub 2018 Feb 21.


Objective: To characterize the impact of premedication with and without a paralytic agent on the safety of tracheal intubation (TI) in infants ≤1500 g.

Study design: A prospective observational cohort study between February 2015 and June 2017. The primary outcomes were associations between the use of different premedication regimens with number of TI attempts, TI adverse events (TIAEs), and changes in heart rate.

Results: Data were collected on 237 TIs. Median postmenstrual age at intubation was 28 completed weeks and weight was 953 g. Premedication with a paralytic was associated with fewer intubation attempts compared to premedication without a paralytic (p = 0.037). Premedication with a paralytic was associated with fewer TIAEs (p < 0.001) and less bradycardia compared to the other two regimens (p = 0.003) compared to premedication without a paralytic.

Conclusions: Premedication with a paralytic was associated with fewer intubation attempts, fewer TIAEs, and less bradycardia. Premedication with a paralytic may improve intubation safety in VLBWs.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Academic Medical Centers
  • Benzodiazepines / therapeutic use*
  • Bradycardia / etiology
  • Bradycardia / physiopathology
  • Female
  • Hospitals, Pediatric
  • Humans
  • Infant, Newborn
  • Infant, Very Low Birth Weight*
  • Intensive Care Units, Neonatal
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / methods*
  • Male
  • Morphine / therapeutic use*
  • Oxygen Consumption
  • Paralysis / physiopathology
  • Paralysis / therapy
  • Premedication / adverse effects
  • Premedication / methods*
  • Prospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Survival Rate
  • Treatment Outcome
  • Washington


  • Benzodiazepines
  • Morphine